Module 3

1. Module 3 Elements of a Staffing Pattern Part 1

2. Staffing Patterns • Staffing Patterns are the foundation of the salary budget • Indicate the number and type of staff needed to care for a specific number and type of patient population • Based on the Unit of Service (UOS) which was identified during the volume projection and the activity of that unit

3. Staffing Pattern • The activity on a unit can be defined in a variety of ways • Beds = the number of beds available for occupancy • Census = number of patients on the unit at a specific time of day (most hospitals use a midnight census, but some desire a more frequent count to identify transfers into and out of a unit) • Percent Occupancy = Census of a unit ÷ beds available x 100. Ex: a unit with a Midnight census of 22 and a bed count of 26, 22 ÷ 26 = .846 x 100 or an occupancy of 84.6 %

4. Staffing Pattern Activity Definition continued • Patient Day = a single patient in a bed for one complete day. • Average Daily Census = number of patient days in a given period ÷ number of days in that period Ex: 765 patient days in March ÷ 31 days in month = ADC of 24.67 • Average Length of Stay = number of patient days in a given period ÷ number of discharges or admission in that time period Ex: 765 patient days in March ÷75 discharges in march = 10.2 as the average of stay for the patients.

5. Staffing Pattern • Each unit/department is assigned a specific unit of service • Nursing units – patient days • OR - # of Cases performed • Labor & Delivery - # of Deliveries • Pharmacy - # of doses dispensed • Emergency Department - # of Visits • To determine the volume of patients projected a conversion of the available data to the unit of service might be necessary • Ex: An increase in OR orthopedic volume by 5% due to a new surgeon. Current Orthopedic volume is 10 cases per week = 520 cases per year and increase of 5% would mean 52 additional cases or 1 per week in the coming year.

6. Staffing Pattern • Now that the volume of a department/ unit has been projected the next step is to identify if there are varying Levels of Care • Volume does not tell the entire needs of the patient. • Some type of measurement of the acuity of the patient should be considered • Patient classification systems allow for the categorization of patients based upon the level of nursing care needed.

7. Staffing Patterns • Types of Patient Classification Systems • Subjective method – a description is developed for each category/level of care requirements. Time requirements are then associated with each level based on the description. Patients are then matched up to the best descriptor of the patient. • Factor isolation method – forms are designed to include all the necessary care factors which the patient might require. The forms are uniquely designed for a specific clinical specialty. Each element has an associated time factor. The total time requirement is determined by the number of elements selected.

8. Staffing Pattern • Either of these methods calculate the appropriate hours of care • Advantage is that the information is “unbiased” based on mathematical formulas. But staff over time learn what to check to increase requirements. Only true unbiased system is to link system to a documentation system where the elements documented as delivered are recorded and time elements are calculated • Disadvantage of most of the systems is the maintenance of the categories and the underlying hours of care. As new methods and equipment change how care is delivered the underlying hours of care an time allocation must be maintained.

9. Staffing Pattern • Many states are reviewing a “standard” hours per patient day or nurse to patient ratios that should be delivered to identified patient populations • California was one of the first states to mandate patient ratios. The ratios are to be maintained 24 hours a day, including breaks and meals.

10. Staffing Patterns • California Ratios by specialty • Critical Care – no less than 1:2 • OR – 1RN circulator, 1 scrub (RN or other) • ED – no less than 1:4 when patient, 2 nurses at all times • Post Anesthesia Care – 1:2 regardless of type of anesthesia • Pediatrics – 1:4 • Step Down – 1:3 • Telemetry – 1:5 • Psychiatry – 1:6 • Med/Surg – 1:5 • Labor & Delivery – 1:2 in labor, 1:4 Antepartum, 1:4 Postpartum with Mother/Baby couplets, 1:6 Postpartum Mothers only

11. Staffing Patterns • House Bill 2273 – Submitted 5/6/09 • To establish direct care registered nurse to patient staffing ratio requirement in hospitals • Rationale • Higher acuity of patients increase need • Inadequate and poorly monitored registered nurse staffing practices that result in too few registered nurses providing direct care • Required staffing ratios help nursing shortage by aiding in recruitment and improve retention

12. Staffing Patterns • House Bill 2273 • The staffing plan needs to provide for each shift on every unit a direct care registered nurse may not be assigned to more than: • 1 patient in OR and Trauma ED • 2 patients in Critical Care Units, L & D Units, and Post Anesthesia Units • 3 patients in Antepartum units, Emergency Room, Pediatric, Step Down and Telemetry Units • 4 patients in Intermediate Care Nursery, Med/Surg Units, Acute Care Psychiatry Unit • 5 patients in rehabilitation units • 6 patients in Postpartum (6 couplets) and well baby units

13. Staffing Patterns • Public Act No. 08-79 (State of Connecticut) – Effective October 1, 2008 • On or after July 1, 2009 each hospital licensed by the Department of Public Health shall make available a prospective nurse staffing plan with a written certification that the nurse staffing plan is sufficient to provide adequate delivery of care • Each hospital shall establish a hospital staffing committee to assist in the preparation of the nurse staffing plan. The committee membership shall be made up of not less than fifty (50) per cent direct patient care givers.

14. Staffing Patterns • Public Act No.08-79 (continued) • Each hospital, in collaboration with its staff committee, shall develop and implement to the best of its ability the prospective nurse staffing plan. • The plan shall include: • Minimum skill mix for each patient care unit in the hospital • Identify the hospital’s employment practices concerning the use of temporary and traveling nurses • Set the level of administrative staffing in each patient care unit • Set the hospital’s process for internal review of the nurse staffing plan